OUR EXPERIENCE OF BILATERAL ADRENALECTOMY FOR ITZENKO- CUSHING SYNDROME
Keywords:
Itsenko- Cushing syndrome, bilateral adrenalectomy, transsphenoidal adenomectomy, ectopic Cushing's syndrome, bilateral corticosteromaAbstract
Purpose: to analyze the results of bilateral adrenalectomy for Itsenko-Cushing syndrome. Material and methods. From the analyzed 16 cases of bilateral adrenalectomy (AE), in 14 it was performed in stages (in 11 cases with Itsenko-Cushing's disease after unsuccessful transsphenoidal adenomectomy (TAE), in 2 - with ectopic Cushing's syndrome (ECS), in 1 - with bilateral corticosteroma), and in two cases – simultaneously (in 2 cases with bilateral corticosteroma). The age of the patients was on average 30.14±4.13 (20-38) years, the ratio of men to women was 1:1.7. in 4 cases, AE was performed transabdominally, and in 28 cases, retroperitoneoscopically. Results. The median follow-up period was 35.5 months. After AE, the vast majority (75%) of patients lost excess weight and achieved a BMI <25 (P < 0.001). A statistically significant improvement was also observed in arterial hypertension (from 93.75% to 50%) (P < 0.005). Before the operation, 56.25% suffered from diabetes mellitus, and after the operation - 18.5%. Acute adrenal insufficiency developed in 25% of patients. Death during the observation period was observed in 18.75% of cases. Conclusion. Bilateral AE is an effective method for treating manifestations of hypercortisolism in patients with SIC. It provides good palliative treatment for DIC with failed TAE and ESIC. Most patients have good survival and good quality of life. Mortality in the postoperative period is directly related to the severity of complications that develop in the preoperative period.
References
Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, et al. The diagnosis of Cushing's syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:1526–40.
Prajapati OP, Verma AK, Mishra A et all. Indian Journal Endocrinology and Metabolism. 2015; 19(6):834-840.
Locatelli M, Vance ML, Laws ER. Clinical review: The strategy of immediate reoperation for transsphenoidal surgery for Cushing's disease. J Clin Endocrinol Metab. 2005;90:5478–82.
Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB, et al. Transsphenoidal resection in Cushing's disease: Undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol (Oxf) 1993;38:73–8.
Thompson SK, Hayman AV, Ludlam WH, Deveney CW, Loriaux DL, Sheppard BC. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing's disease: A 10-year experience. Ann Surg. 2007;245:790–4.
Ritzel K, Beuschlein F, Mickisch A, Osswald A, Schneider HJ, Schopohl J, et al. Clinical review: Outcome of bilateral adrenalectomy in Cushing's syndrome: A systematic review. J Clin Endocrinol Metab. 2013;98:3939–48.
